Locally recurrent rectal cancer - Predictors and success of salvage surgery

PURPOSE: After curative surgery for rectal cancer, patients with pelvic rec urrence may undergo curative surgical resection. We determined whether salv age surgery in appropriately selected patients could significantly lengthen disease-free survival time and if so what factors predicted this outcome. METHOD: We reviewed the records of all patients treated for rectal cancer a t our institution between 1980 and 1993. Of 937 patients who underwent surg ery with curative intent after proctectomy or transanal local excision, 81 (8.6 percent) experienced local recurrence. During the same period 36 patie nts with locally recurrent rectal cancer were referred from other instituti ons. Logistic regression analysis was used to identify predictors of salvag e surgery. The Kaplan-Meier method was used to estimate cancer-specific and disease-free survival times in 43 patients who underwent salvage surgery. The Cox proportional hazard model was used to identify factors associated w ith these outcomes. RESULTS: Of 117 patients with locally recurrent rectal cancer, 43 (36.7 percent) underwent salvage surgery. Factors associated wit h higher chance of receiving salvage surgery were female gender, the first operation performed at outside institutions, and transanal local excision a s the initial operation. For 43 patients who underwent salvage surgery, fiv e-year cancer-specific and disease-free survival rates were 49.7 and 32.2 p ercent, respectively. No factors were significantly associated with death c aused by cancer. However, a trend for poor prognosis was observed in patien ts with recurrence diameter >3 cm and tumor fixation Degree 2. CONCLUSION: Salvage surgery for properly selected patients with locally recurrent recta l cancer allows long-term palliation and significantly lengthens disease-fr ee survival.